磁共振成像动态增强扫描联合T2WI及DWI序列对前列腺病变的诊断分析

Diagnosis analysis of prostate lesions by dynamic contrast⁃enhanced magnetic resonance imaging combined with T2 weighted imaging and diffusion weighted imaging sequences

目的 探究磁共振成像动态增强扫描(DCE-MRI)联合T2加权成像(T2WI)及扩散加权成像(DWI)在前列腺病变中的诊断价值。方法 选取川北医学院附属南充市中心医院2019年10月至2021年10月收治的452例疑似前列腺癌(PCa)的前列腺病变患者,均行MRI及DWI扫描。以病理结果为金标准,分析DCE-MRI联合T2WI及DWI对前列腺病变的诊断价值。结果 病理学检出良性327例,恶性125例。DCE-MRI联合T2WI及DWI检查检出良性300例,恶性152例,对PCa的诊断灵敏度、特异度和准确度分别为92.80%(116/125)、88.99%(291/327)、90.04%(407/452)。前列腺增生主要为组织对称性均匀增大,中央带可见增生结节,病灶组织影像学轻薄,DWI表现为较均匀中等或稍高信号。PCa在T2WI序列上表现为高信号周围带中的低信号结节,病灶向外扩张时呈现不对称性增大趋势,周围脂肪间隙受侵;DWI表现为高信号,且明显高于周围正常组织。在DWI量化分析中,良性病灶和恶性病灶的平均表观扩散系数(ADC)值差异具有统计学意义(t=13.218,P<0.001)。在受试者工作特征(ROC)曲线诊断评估分析中,ADC对PCa具有较高诊断价值(AUC=0.815),其诊断灵敏度、特异度、最佳临界值、渐进95%CI分别为60.3%、90.6%、1.165、0.147~0.224。结论 DCE-MRI联合T2WI及DWI对前列腺病变诊断特异度较高,具有临床应用价值。

Objective To explore the diagnostic value of dynamic contrast⁃enhanced magnetic resonance imaging(DCE⁃MRI)combined with T2 weighted imaging(T2WI)and diffusion weighted imaging(DWI)in prostate lesions.Methods A total of 452 patients with prostate diseases suspected of prostate cancer(PCa)admitted to Nanchong Central Hospital,North Sichuan Medical College from October 2019 to October 2021 were selected for MRI and DWI scanning.Using pathological results as the gold standard,the evaluation value of DCE⁃MRI combined with T2WI and DWI in prostate lesions was analyzed.Results Pathological test showed that 327 cases were benign hyperplasia and 125 cases were malignant.The sensitivity,specificity and accuracy of DCE⁃MRI combined with T2WI and DWI in the diagnosis of PCa were 92.80%(116/125),88.99%(291/327)and 90.04%(407/452),respectively.Prostatic hyperplasia was mainly characterized by symmetrical and uniform enlargement of tissues.Hyperplasia nodules could be seen in the central zone.The histology of the lesions was light and thin.DWI showed a relatively uniform medium or slightly high signal.On T2WI,PCa showed low signal nodules in the high signal peripheral zone.When the lesions expanded outwards,they showed an increasing trend of asymmetry,and the peripheral fat space was invaded.DWI showed high signal intensity,which was significantly higher than the surrounding normal tissues.In DWI quantitative analysis,there was a statistically significant difference between the average apparent diffusion coefficient(ADC)value of benign lesions and malignant lesions(t=13.218,P<0.001).In the receiver operating characteristic(ROC)curve diagnostic evaluation analysis,ADC has a high diagnostic value for PCa(AUC=0.815),and its diagnostic sensitivity,specificity,optimal critical value,and progressive 95%CI were 60.3%,90.6%,1.165,0.147⁃0.224,respectively.Conclusions DCE⁃MRI combines with T2WI and DWI has high specificity in the diagnosis of prostate diseases,and has clinical application value.